Minimally invasive colectomies can be performed with similar outcomes to open counterparts for colorectal cancer emergencies: a propensity score matching analysis utilizing ACS-NSQIP

PURPOSE

The safety and feasibility of minimally invasive surgery (MIS) in the setting of colorectal cancer emergencies have been debated. We sought to compare postoperative outcomes of MIS with open techniques in the setting of colorectal cancer emergencies from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

METHODS

We included patients undergoing colectomy for colorectal cancer emergency between 2012 and 2019 "2012-2019" from the ACS-NSQIP dataset. We compared short-term morbidity, mortality, short-term oncological outcomes, and secondary outcomes for MIS vs open colectomies using propensity score matching. We then evaluated the trends of MIS versus open colectomies using linear regression analysis.

RESULTS

We examined a total of 5544 patients (open n = 4070; MIS n = 1474) and included 1352 patients for our postoperative outcome analyses after propensity score matching 1:1 (open n = 676; MIS n = 676). Within the matched cohort, mortality was significantly higher in the open group (open 6.95% vs MIS 3.99%, OR 1.8, p = 0.023). Anastomotic leak rates were comparable between the  two groups (open 4.46% vs MIS 4.02%, OR 1.12, p = 0.787). Pulmonary complications were significantly higher after open surgery (open 10.06% vs MIS 4.73%, OR 2.25, p < 0.001). Rates of ileus were significantly higher amongst open patients (open 29.08% vs MIS 19.94%, p < 0.001). Patients stayed on average 1 day longer in the hospital after open surgery (p < 0.001). Rates of MIS for early tumors (N0 and T1/T2, n = 289) did not significantly change over 7 years (p = 0.597, rate = - 0.065%/year); however, utilization of MIS for late tumors (N1 or T3/T4, n = 4359) increased by 2.06% per year (p < 0.001).

CONCLUSIONS

This study demonstrates that MIS was associated with superior postoperative outcomes compared to open surgery without compromising oncological outcomes in patients undergoing emergency colectomy for colon cancer. Within the matched cohort, MIS was associated with lower rates of mortality, pulmonary complications, ileus, and shorter postoperative length of stay.

Targeted Endodontic Microsurgery: Implications of the Greater Palatine Artery

INTRODUCTION

Targeted Endodontic Microsurgery (TEMS) combines trephine burs and 3D-printed guides to make flapless maxillary palatal root-end surgery possible. This study assessed the location of the greater palatine artery (GPA), the relationship of the GPA to maxillary molar root ends, and the feasibility of flapless palatal-approach TEMS.

METHODS

Three endodontists analyzed 250 cone-beam computed tomographic images of maxillary molars for (1) transition morphology between the hard palate and the alveolar process adjacent to first and second molars as an indication of the most likely location of the GPA, (2) the superior-inferior relationship between the GPA and root ends, and (3) the feasibility of palatal-approach TEMS.

RESULTS

Palatal transition morphology included 20% Spine, 72% Bridge, and 8% Smooth. GPA position as related to palatal root ends was classified as 34% superior, 40% adjacent, and 21% inferior. Five percent of classifications were undefined. TEMS was deemed feasible for 47% of maxillary first molars and 52% of second molars, and was significantly more feasible with GPAs superior to palatal root ends. Reasons for infeasibility included GPA proximity and unfavorable resection angle or level. Maxillary first molar palatal roots were 11.13 ± 2.68 mm from the greater palatine foramen (GPF) and 2.37 ± 1.46 mm from the GPA. Second molar palatal roots were 4.94 ± 2.55 mm from the GPF and 2.53 ± 1.77 mm from the GPA.

CONCLUSIONS

Palatal transition morphology and GPA position adjacent to maxillary molars, as manifested in cone-beam computed tomographic coronal views, suggested maxillary palatal root TEMS could be accomplished with a 2-mm safety margin in 47% of first molars and 52% of second molars. Historical paradigms that do not consider flapless palatal surgical approaches may need to be revised.

Cyclic fatigue resistance and metallurgic comparison of rotary endodontic file systems

The aim of this study was to compare, in pairs, the cyclic fatigue resistance, scanning electron microscopic (SEM) appearance, and energy-dispersive X-ray (EDX) profiles of 6 rotary files: ProTaper Gold vs EdgeTaper Platinum; ProTaper Universal vs EdgeTaper; and Vortex Blue vs EdgeSequel Sapphire. Six types of rotary file were tested in 2 sizes of each type. A 3-point cyclic fatigue apparatus imparting a 60-degree angle of curvature and a 3-mm radius of curvature was used to evaluate 30 files of each type and size. The cyclic fatigue testing results from similar file types and sizes were paired for statistical analysis. After fatigue testing was completed, 36 files (3 of each type and size) were randomly selected for SEM imaging and EDX analysis. When similar file types and sizes were paired in independent-samples t tests, statistically significant differences (P < 0.0001) in cyclic fatigue resistance were established. For both tested sizes, EdgeTaper Platinum exhibited significantly greater fatigue resistance than ProTaper Gold. ProTaper Universal and EdgeTaper each demonstrated significantly greater fatigue resistance than the other system in 1 size pairing. Vortex Blue exhibited significantly greater fatigue resistance than EdgeSequel Sapphire in both size pairings. In general, the heat-treated files demonstrated greater cyclic fatigue resistance than the non-heat-treated files. The SEM images verified that fracture patterns were consistent with cyclic fatigue failure. Differences in file design between the matched pairs were noted, particularly at the tips. The EDX comparisons showed that nickel and titanium were present in similar percentages (1:1 atomic ratio) for all file types. The disparities in cyclic fatigue results and tip design indicate that clinicians should not expect identical clinical performance from different files.

Healing of apical periodontitis through modern endodontic retreatment techniques

The presence of apical periodontitis in teeth which have undergone initial root canal treatment is largely attributed to bacteria residing in or invading from the apical root canal space. Bacteria-associated apical periodontitis will not heal spontaneously, nor will systemic antibiotics eradicate the infection. Only endodontic retreatment, endodontic surgery, or extraction will control the bacterial etiology. Modern retreatment is an effective means of addressing apical periodontitis. A mandibular premolar with apical periodontitis, apical root resorption, and overfilled gutta percha was retreated with post removal, retrieval of gutta percha from beyond the apex, ultrasonic irrigation and disinfection, and placement of a collagen internal matrix to facilitate a well-controlled MTA apical fill. The magnification and illumination imparted by the operating microscope was integral to achievement of treatment objectives. The patient's symptoms were resolved and complete osseous healing occurred. During treatment planning, clinicians should consider the capability of modern endodontic techniques to overcome technical challenges, often allowing the natural dentition to be preserved and restored to function days after retreatment.

Authoritarianism, Dominance and Assertiveness

It is shown that there are definitions of the three constructs of authoritarianism, dominance and assertiveness which read very similarly; so much so that no distinction is immediately evident. It is proposed that authoritarianism might be conceived as aggressive dominance and at least some types of assertiveness as nonaggressive dominance. A new scale of Dominance suitable for general population use was produced, and compared with the existing Ray (1976) behavior inventory of authoritarianism. Both scales showed highly significant correlations with peer rated dominance and submission (the latter being negative in sign) but only the authoritarianism scale showed significant correlations with rated aggressiveness and rigidity. It was concluded that the new definitions could be operationalized into valid scales.

If 'A-B' does not predict heart disease, why bother with it? A comment on Ivancevich & Matteson

A recent article by Ivancevich & Matteson notes many problems with research into the 'A-B' personality but recommends continued research into the construct. It is pointed out that these authors omit consideration of much of the relevant literature and that, when the omitted work is included, the 'A-B' construct must be viewed as a false trail which should now be abandoned.

Authoritarianism as a cause of heart disease: reply to Byrne, Reinhart & Heaven

Byrne, Reinhart & Heaven (1989) report a study which replicates many findings of the present author. They interpret their findings, however, to create the impression that they somehow undermine a theory advanced by the present author. Reasons for this are explored and important omissions are noted.

Delinquency and attitude to authority: a comment on Reicher and Emler

In their study of self-reported delinquency, Reicher & Emler (1985) use an ad hoc scale to measure attitudes to authority rather than one of the well-validated scales already in the literature. The items they finally used were almost all anti-authority--thus rendering their results susceptible of an explanation in terms of acquiescent response bias. It is shown that such an explanation would indeed provide a powerful account of what they found. Their work is therefore of uncertain meaning.

Smoking and intelligence in Australia

It is difficult to test the link between intelligence and smoking directly. A hypothetico-deductive approach is therefore used and it is hypothesized that members of the Mensa club will have low rates of smoking. A postal survey of 402 Australian Mensa members revealed incidence rates of 22% for males and 15% for females. This is roughly half the general population incidence rate in both Australia and the U.K. It is concluded that the results do support the view of smoking as a sign of general social disadvantage.

Machiavellianism, forced-choice formats and the validity of the F scale: a rejoinder to Bloom

Bloom has defended the forced-choice form of the Machiavellianism scale from observations by Ray that such scales have intrinsic validity problems--particularly with social desirability. Bloom also has shown that the failure of the F scale to predict authoritarian behavior does not necessarily deprive it of all claims to validity. It is pointed out that Bloom's observations contain nothing new and ignore important considerations. The validity problems of forced-choice format are elaborated by means of examples, and it is pointed out that Bloom appears to lack criteria for ever allowing the F scale to be shown as invalid.

Toward a definitive alienation scale

Alienation is one of the most widely used constructs in sociology. Unfortunately, it is not clear that it is always the same construct as a wide diversity of scales is used to measure it. In the present work an attempt has been made to gather together all items of published scales said to measure alienation and see what they had in common: 168 items were collected and administered to a diverse community sample and were found to form a highly reliable scale which could be reduced to only 20 central items with little loss of reliability.

Is authoritarianism the main element of the coronary-prone personality?

Clients at the Sydney Coronary Heart Disease Prevention Programme were screened for actual CHD and sufferers were compared with non-suffers on four personality scales to measure, respectively, A-B, dominance, achievement motivation and 'freneticism'. There were 112 sufferers and 201 controls. Sufferers were found to have significantly higher scores on dominance-the Ray (1976) Directiveness scale-but also to have significantly lower scores on the A-B measure. This latter reversal of the usual relationship was an artifact of the fact that older people are both more CHD prone and get lower A-B scores. When age was controlled for there was no relationship between A-B type and CHD. This left the authoritarian style of dominance measured by the Directiveness scale as the sole predictor of CHD. This was held to be a belated vindication of claims made in the pioneering work of Dunbar (1943).

Dissecting the A-B personality type

It is suggested that 'freneticism' might be an appropriate name for the type of personality said by Rosenman, Friedman and Jenkins to be at risk from coronary heart disease. In study 1 the measure of this personality type (the JAS) was given a uniform answer format and, as such, was found to give improved reliability. It was administered to a random postal sample of Australians. A short form of 24 items was also produced. In study 2 a similar sample received the 24-item form and scales to measure achievement motivation, dominance and extraversion. 'A' types were found to be very much achievement motivated and dominant. A factor analysis showed these two traits as the main components of the A-B concept with only a third factor of 'freneticism'. This factor was measured in a third study which showed that the factor could be used as a scale in its own right.

Is the Acquiescent Response Style Problem Not So Mythical After All? Some Results From a Successful Balanced F Scale

It is shown that Rorer's exoneration of the F scale from acquiescent response style contamination is dependent on the finding-that various acquiescence measures fail to intercorrelate. When acquiescence is measured as the total score on adequate balanced scales scored without reversals, significant internal reliability is found. It is found, in fact, even with scales that are not particularly ambiguous. It is concluded that some scales are not responded to meaningfully by some people and if these people are not to be confounded with real high scores, balancing against acquiescence is still needed.

Do mental events exist? Physiological adumbrations

In this paper, elaboration of a Realist answer to some of the classical questions of psychology and epistemology will be sought, starting from a knowledge of Soviet and Western findings in psychophysiology (particularly the work of Pavlov, 1932, and Hebb, 1949; see also the summary by Burt, 1968). The point of departure taken in the philosophical literature is the paper by Place (1969). This paper will adopt a reflexological model of brain function—with its implied view that memory is synaptically encoded. While this model has largely fallen into disfavour it is used here paradigmatically—to show that well-developed physiological models in general can provide a satisfactory account of ‘mental’ phenomena.